Lesch-Nyhan Syndrome care technology platforms are the digital infrastructure underpinning modern management of Lesch-Nyhan Syndrome — the X-linked recessive disorder of purine metabolism caused by hemizygous pathogenic variants in HPRT1 encoding hypoxanthine-guanine phosphoribosyltransferase, the enzyme catalyzing the salvage pathway reconversion of hypoxanthine and guanine to their respective monophosphate nucleotides IMP and GMP using phosphoribosyl pyrophosphate as the phosphoribosyl donor — the complete absence of HPRT1 enzymatic activity eliminating the purine salvage pathway that normally recovers approximately 90% of the hypoxanthine and guanine generated from nucleic acid catabolism and the ongoing turnover of purine nucleotides, forcing these purines instead through xanthine oxidase-catalyzed oxidation to uric acid with consequent hyperuricemia and hyperuricosuria producing gouty arthritis, uric acid nephrolithiasis, and obstructive nephropathy, while simultaneously depriving the central nervous system of the HPRT1-mediated GTP regeneration and purine recycling capacity required for dopaminergic neurotransmitter synthesis, basal ganglia neuromodulation, and synaptic function in the dopamine-rich striatum and substantia nigra circuits where HPRT1 expression is highest, generating the severe neurological phenotype that uniquely characterizes Lesch-Nyhan Syndrome beyond the biochemical hyperuricemia: hypotonia evolving to dystonia in the first year of life, choreoathetosis and ballismus superimposed on baseline dystonia, progressive spastic features, absent or severely impaired ambulation, dysarthria and dysphagia, cognitive impairment variable from mild to moderate, and the pathognomonic self-injurious behavior including compulsive self-biting of lips and fingers and head-banging that emerges during the second year of life and represents one of the most distinctive and clinically demanding behavioral phenotypes in any genetic disorder — integrating Lesch-Nyhan Syndrome rare disease registry platforms, uric acid surveillance and allopurinol management platforms tracking serum uric acid levels with therapeutic response monitoring, nephrology surveillance platforms tracking renal function and urological complications from chronic hyperuricosuria, behavioral intervention scheduling and restraint protocol management platforms for self-injurious behavior programs, neurology care coordination platforms for dystonia and movement disorder management with medication trial documentation, gastroenterology and feeding management platforms for dysphagia and aspiration risk surveillance, and multidisciplinary care coordination tools enabling metabolic disease specialists, neurologists, nephrologists, psychiatrists, behavioral therapists, and feeding specialists to deliver the comprehensive, continuous management that the biochemical, neurological, and behavioral complexity of Lesch-Nyhan Syndrome demands across the lifespan. When a Lesch-Nyhan Syndrome care platform is unavailable or degraded, providers cannot access serum uric acid trend data, allopurinol dosing records, renal function results, behavioral intervention protocol documentation, dystonia medication records, dysphagia assessment reports, and HPRT1 registry contribution interfaces that guide the expert longitudinal management of this X-linked purine metabolism disorder where biochemical control of hyperuricemia is achievable but neurological and behavioral management remains a lifelong complex challenge.
This guide covers what Lesch-Nyhan Syndrome care technology platforms need to monitor, why continuous availability matters for a condition requiring simultaneous biochemical uric acid control, renal protection, behavioral management infrastructure, and neurological care coordination across the lifespan, and how to build a monitoring strategy that protects allopurinol management platforms, renal surveillance systems, behavioral intervention coordination, and the multidisciplinary management infrastructure that Lesch-Nyhan Syndrome care requires.
Why Lesch-Nyhan Syndrome Care Tech Platforms Cannot Afford Downtime
Lesch-Nyhan Syndrome management combines a pharmacologically achievable biochemical goal — uric acid lowering with allopurinol or febuxostat to prevent gout, nephrolithiasis, and renal failure — with a far more complex and incompletely treatable neurological and behavioral management program for dystonia, self-injurious behavior, and the cognitive and communicative challenges that substantially affect quality of life. Biochemical management requires continuous laboratory surveillance and medication management infrastructure; behavioral management requires continuous access to restraint protocol documentation, behavioral intervention scheduling, and multidisciplinary behavioral team coordination. Both domains must be continuously available because biochemical and behavioral crises can occur at any time and require immediate access to current management documentation.
Uric acid control is a continuous biochemical safety requirement. Allopurinol, an xanthine oxidase inhibitor, effectively suppresses uric acid production in Lesch-Nyhan Syndrome by blocking the conversion of hypoxanthine and xanthine to uric acid. However, therapeutic uric acid suppression requires precise allopurinol dosing, regular serum uric acid monitoring to confirm target achievement, and renal function surveillance because allopurinol is renally cleared and dosing must be adjusted with declining GFR. Platforms that fail during allopurinol dose adjustment periods risk allowing serum uric acid to rise to gout-precipitating or nephropathy-inducing levels from missed monitoring or dosing documentation gaps.
Self-injurious behavior management is a continuous behavioral safety domain. Lesch-Nyhan Syndrome self-injurious behavior — including compulsive self-biting, head-banging, and limb self-injury — is neurologically driven and incompletely suppressible by willpower or extinction-based behavioral modification; patients typically require physical restraint of varying degrees, dental protection devices, and behavioral management programs that balance the patient's apparent paradoxical ambivalence toward the self-injury (many patients request restraint as protective) against quality of life and functional independence. Behavioral intervention protocol platforms documenting current restraint levels, protective device specifications, behavioral medication regimens, and the individualized behavioral management program must remain continuously available to every caregiver, nursing staff member, and behavioral health provider interacting with the patient.
Renal function is at ongoing risk from chronic hyperuricosuria. Even adequately allopurinol-treated patients with Lesch-Nyhan Syndrome retain some degree of xanthine excretion — because allopurinol blocks conversion of hypoxanthine and xanthine to uric acid, xanthine itself can accumulate and cause xanthine nephropathy or xanthine lithiasis in the setting of very high purine turnover. Combined with the historical uric acid nephropathy risk, renal function surveillance is a lifelong monitoring requirement in Lesch-Nyhan Syndrome.
What to Monitor on a Lesch-Nyhan Syndrome Care Tech Platform
Uric Acid Control and Allopurinol Management Platform
The serum uric acid surveillance and allopurinol management service — integrating serum uric acid quantification at 4 to 8-week intervals during allopurinol dose optimization and at 3-month intervals once stable control is documented with target serum uric acid below 360 µmol/L (6 mg/dL) confirmed, allopurinol dose prescription tracking with weight-based dose calculation documentation and renal function-adjusted dose modification records, serum oxypurine monitoring — hypoxanthine and xanthine plasma levels — at 3 to 6-month intervals documenting the degree of purine substrate shift from uric acid to oxypurine excretion on allopurinol, urine oxypurine quantification tracking xanthine and hypoxanthine urinary excretion rates that indicate xanthine nephropathy and xanthine lithiasis risk on high-dose allopurinol, febuxostat alternative therapy records for patients with allopurinol intolerance or hypersensitivity, uric acid crystal surveillance in joint aspirate result integration for patients presenting with acute arthritis despite biochemical control, and allopurinol drug interaction monitoring for patients on other medications that affect xanthine oxidase or renal uric acid handling — is the biochemical safety foundation for Lesch-Nyhan Syndrome management. Check at a 1-minute interval. Allopurinol management platform failures risk dosing record gaps that allow serum uric acid to rise to gout-precipitating levels or allow unmonitored xanthine accumulation with nephrolithiasis risk.
Renal Function and Urological Surveillance Platform
Monitor the renal function assessment and urological monitoring service — including serum creatinine and estimated GFR at 3-month intervals documenting renal function trajectory with allopurinol dose adjustment when GFR declines affecting allopurinol clearance, cystatin C-based GFR estimation for patients with muscle wasting affecting creatinine-based GFR accuracy, urine albumin-to-creatinine ratio at 3-month intervals tracking tubular and glomerular proteinuria from crystalluria-related nephron damage, renal ultrasound at 6-month intervals documenting the absence of nephrolithiasis, nephrocalcinosis, and collecting system obstruction from urate or xanthine crystal accumulation, 24-hour urine uric acid and oxypurine quantification at 6-month intervals confirming urinary purine excretion patterns on allopurinol, urological consultation scheduling when renal ultrasound documents calculi requiring urological assessment, acute renal function deterioration alerting linking rising creatinine or reduced urine output to urgent nephrology escalation, and hydration protocol documentation tracking adequate daily fluid intake recommendations to maintain dilute urine and reduce urinary crystal precipitation risk — at a 1-minute interval. Renal protection is a life-expectancy determinant in Lesch-Nyhan Syndrome; the historical cause of premature mortality in inadequately managed patients was renal failure from urate nephropathy, and contemporary renal surveillance prevents this complication with early detection.
Self-Injurious Behavior Management and Restraint Protocol Platform
Monitor the behavioral intervention management and self-injurious behavior protocol service — including current restraint level documentation for each patient — specifying wrist restraints, elbow extension restraints, trunk support devices, and dental protection equipment currently prescribed and in use — behavioral management protocol documentation tracking the individualized SIB management program developed with behavioral psychology, the behavioral medication regimen tracking baclofen, benzodiazepines, gabapentin, or dopaminergic agents trialed for SIB reduction with response and adverse effect documentation, behavioral escalation alert protocols documenting the threshold criteria for increased restraint implementation, emergency behavioral management protocol access for acute SIB crisis events where injury risk requires immediate staff intervention, caregiver training documentation tracking completion of behavioral management training for family caregivers responsible for home restraint implementation, dental protection device prescription and replacement records, nursing staff behavioral management competency documentation, and behavioral psychology consultation scheduling at 3 to 6-month intervals for behavioral management protocol review and optimization — at a 1-minute interval with immediate escalation. Self-injurious behavior management platforms must be the highest-availability systems in the Lesch-Nyhan Syndrome care platform suite because a caregiver without access to the current restraint protocol documentation for an individual patient represents an acute patient safety risk; any moment of SIB management protocol platform unavailability in a clinical or residential setting is an emergency.
Dystonia and Movement Disorder Management Platform
Monitor the dystonia and movement disorder management service — including the dystonia severity assessment documentation tracking the dystonia rating scale scores, functional independence measure results, and mobility assessment documentation at 3-month intervals, baclofen pump management records for patients with intrathecal baclofen therapy — including pump refill scheduling, drug concentration documentation, and pump telemetry data integration, oral baclofen, diazepam, clonazepam, levodopa, tetrabenazine, or deep brain stimulation trial documentation with response rating and adverse effect tracking, physical therapy program documentation tracking range of motion, positioning, and spasticity management interventions, wheelchair and adaptive equipment prescription and modification records for optimizing mobility and positioning in the setting of dystonia and spasticity, deep brain stimulation parameter programming records for patients in whom DBS has been implemented — requiring immediate access to programming parameters for patients presenting with acute neurological change, aspiration and fall event documentation tracking neurological complication events, and neurology consultation scheduling at 3 to 6-month intervals for movement disorder management optimization — at a 2-minute interval. Dystonia management is both a quality-of-life and a medical safety domain in Lesch-Nyhan Syndrome; inadequate spasticity and dystonia management produces contractures, aspiration events from dysphagia, and self-injury potentiation from involuntary motor movements that overcome protective restraints.
Dysphagia, Feeding Safety, and Gastroenterology Platform
Monitor the dysphagia assessment and feeding management service — including modified barium swallow study and fiberoptic endoscopic evaluation of swallowing result integration documenting aspiration risk severity and the specific food texture and liquid viscosity modifications required for safe oral feeding, texture-modified diet prescription documentation specifying IDDSI level for solids and liquid thickening requirements, gastrostomy tube management records for patients who have transitioned to tube feeding because oral feeding aspiration risk exceeds safe management thresholds, aspiration pneumonia event documentation tracking pulmonary complication events with hospitalization and antibiotic treatment records, pulmonology consultation scheduling for patients with recurrent aspiration pneumonia requiring chronic aspiration management, gastroenterology consultation scheduling for gastroesophageal reflux management that may exacerbate aspiration risk, nutritional status monitoring including weight and body composition tracking relative to the caloric requirements of a patient with high involuntary motor activity from dystonia, and feeding therapy scheduling for patients with swallowing dysfunction not yet requiring tube feeding — at a 2-minute interval. Aspiration from dysphagia is a major cause of acute morbidity and mortality in Lesch-Nyhan Syndrome; feeding safety platform failures interrupt the documentation that specifies safe feeding modifications and aspiration management protocols for care staff in clinical and residential settings.
Behavioral Medications and Neuropsychiatric Management Platform
Monitor the behavioral medication management and neuropsychiatric surveillance service — including the psychotropic medication regimen documentation tracking all agents trialed or currently prescribed for SIB reduction, anxiety, agitation, or mood — including the specific agents, doses, response ratings, and adverse effect documentation, medication reconciliation at every clinical encounter ensuring complete and current behavioral medication documentation is accessible to all treating clinicians, behavioral pharmacy consultation records for patients on complex multi-drug behavioral management regimens, adverse drug reaction documentation and monitoring including allopurinol hypersensitivity syndrome surveillance, sedation monitoring for patients on higher-dose benzodiazepine or baclofen regimens, behavioral change alerting linking caregiver-reported acute behavioral escalation to neuropsychiatric consultation notification, and psychiatric consultation scheduling for patients with mood disorder, anxiety, or behavioral symptoms requiring specialist evaluation beyond the primary SIB management program — at a 2-minute interval. Behavioral medication management in Lesch-Nyhan Syndrome requires both completeness and accessibility; a clinical or residential care team that cannot access the current behavioral medication record for a patient presenting with acute behavioral escalation or adverse drug effect cannot safely manage the patient.
Cognitive and Communication Support Platform
Monitor the cognitive assessment and communication support service — including cognitive function assessment at 12-month intervals using adapted neuropsychological testing tools suitable for patients with significant motor disability affecting standard test performance, augmentative and alternative communication system programming and support records for patients using AAC devices — including vocabulary configuration, access method settings, and device maintenance documentation, speech-language pathology assessment at 6-month intervals documenting communication function trajectory and AAC system effectiveness, educational and vocational support coordination records for school-age and adult patients, quality of life assessment documentation using validated patient-reported or proxy-reported measures, and social work coordination records for family support, residential placement, and community service coordination — at a 2-minute interval. Cognitive and communication support platforms enable care staff to understand and respond to patients' expressed preferences, including the paradoxical preference that many Lesch-Nyhan Syndrome patients express for protective restraint, making communication platform availability a component of behavioral safety management.
HPRT1 Registry and Genetic Counseling Platform
Monitor the rare disease registry and genetic counseling coordination service — including HPRT1 Lesch-Nyhan Syndrome registry enrollment with longitudinal phenotype documentation tracking neurological severity, SIB severity and management approach, uric acid control history, renal function trajectory, behavioral medication response, and long-term functional outcomes, genetic counseling scheduling for mothers of affected males — X-linked inheritance with 50% risk of transmitting the carrier state to daughters and 50% risk of transmitting Lesch-Nyhan Syndrome to sons — carrier testing coordination for at-risk female relatives, prenatal diagnosis coordination via HPRT1 molecular testing on chorionic villus sampling for carrier mothers in subsequent pregnancies, preimplantation genetic testing coordination for carrier females planning assisted reproduction, genotype-phenotype correlation documentation tracking the relationship between specific HPRT1 variant combinations and neurological severity — the Lesch-Nyhan Syndrome phenotypic spectrum from gout-only (partial HPRT1 deficiency) through Lesch-Nyhan Variant (neurological features without SIB) to classic Lesch-Nyhan Syndrome (complete loss with full SIB phenotype), and natural history data contribution tracking survival, renal function trajectory, SIB management outcomes, and quality of life metrics — at a 5-minute interval. The HPRT1 registry generates evidence for the genetic epidemiology and natural history of Lesch-Nyhan Syndrome, informing renal surveillance protocols, SIB management guidelines, and genetic counseling frameworks.
EHR Integration Endpoint
Monitor the EHR synchronization service at a 5-minute interval. Lesch-Nyhan Syndrome patients presenting to emergency departments or urgent care settings require immediate clinical staff access to current allopurinol dose and last serum uric acid value, renal function results, complete behavioral restraint protocol and dental protection documentation, current behavioral medication regimen, intrathecal baclofen or DBS parameter documentation, dysphagia assessment and safe feeding protocol, and active specialist co-management documentation.
Authentication Service
Monitor authentication at a 1-minute interval. Auth failures simultaneously lock metabolic disease specialists, neurologists, nephrologists, behavioral psychologists, nursing staff, and residential care providers out of uric acid management platforms, behavioral restraint protocol systems, renal surveillance dashboards, and dysphagia management documentation.
SSL Certificates Across All Platform Domains
Monitor certificate expiry 30 days in advance across all patient-facing, clinician-facing, and registry integration domains.
Alerting Strategy for Lesch-Nyhan Syndrome Care Tech Platforms
Immediate clinical escalation (24/7): Self-injurious behavior management and restraint protocol platform, uric acid control and allopurinol management platform, renal function and urological surveillance platform, authentication service. SIB protocol availability is an acute patient safety requirement at all hours; uric acid control and renal protection are continuous biochemical safety domains.
Immediate clinical operations escalation: Dysphagia, feeding safety, and gastroenterology platform, dystonia and movement disorder management platform, behavioral medications and neuropsychiatric management platform. Failures affect feeding safety management, movement disorder care, and behavioral medication documentation critical for care staff.
High-priority escalation: Cognitive and communication support platform. Communication platform failures impair patients' ability to express preferences including protective restraint requests.
Business-hours escalation: HPRT1 registry and genetic counseling platform, EHR synchronization. Investigate within one business hour.
Advance warning: SSL certificate expiry, 30 days in advance.
Status Page as a Clinical Safety Signal
Lesch-Nyhan Syndrome patients live in clinical, residential, and home settings where care staff require continuous access to behavioral protocol documentation, restraint specifications, and feeding safety information. Platform status visibility is a patient safety requirement. Publish the status page URL in residential care facility workstations, hospital neurology and metabolic disease clinic systems, emergency department clinical decision support platforms, and family caregiver portal communications.
The Business Case: Biochemical Control and Behavioral Safety Program Excellence
Lesch-Nyhan Syndrome specialty programs face quality exposure across multiple simultaneously monitored clinical domains: uric acid management failures that allow hyperuricemia to progress to acute gouty arthritis or accelerated renal urate nephropathy, renal surveillance failures that miss xanthine nephropathy or nephrolithiasis requiring urological intervention, behavioral protocol platform failures that leave care staff in residential or clinical settings without access to current restraint specifications and SIB management protocols creating acute patient safety events, dystonia management failures that interrupt spasticity and positioning management records producing contracture risk, and dysphagia platform failures that interrupt safe feeding protocol documentation creating aspiration risk. The comprehensive nature of Lesch-Nyhan Syndrome management — spanning biochemical, urological, behavioral, neurological, and nutritional domains simultaneously — means that platform reliability across all domains is required to maintain the standard of care that protects patients from the full range of Lesch-Nyhan Syndrome complications. External monitoring from Vigilmon provides the independent availability record that Lesch-Nyhan Syndrome program directors can present to movement disorder networks, rare disease foundations, and residential care providers as evidence of continuous digital infrastructure supporting the comprehensive management that HPRT1 deficiency requires.
Vigilmon Setup for Lesch-Nyhan Syndrome Care Tech Platforms
A practical starting configuration:
| Monitor | Check Interval | Alert Channel | |---------|----------------|---------------| | Self-injurious behavior management and restraint protocol platform | 1 min | PagerDuty (immediate, 24/7) | | Uric acid control and allopurinol management platform | 1 min | PagerDuty (immediate, 24/7) | | Renal function and urological surveillance platform | 1 min | PagerDuty (immediate, 24/7) | | Auth service | 1 min | PagerDuty (immediate) | | Dysphagia, feeding safety, and gastroenterology platform | 2 min | PagerDuty (immediate) | | Dystonia and movement disorder management platform | 2 min | PagerDuty (immediate) | | Behavioral medications and neuropsychiatric management platform | 2 min | PagerDuty (immediate) | | Cognitive and communication support platform | 2 min | Slack (business hours) | | HPRT1 registry and genetic counseling platform | 5 min | Slack (business hours) | | EHR synchronization endpoint | 5 min | Slack (business hours) | | SSL: all platform domains | Daily | Email (30-day warning) |
Getting started:
- Create a free account at vigilmon.online
- Add self-injurious behavior management and restraint protocol monitoring at a 1-minute interval with 24/7 PagerDuty alerting — SIB protocol availability is a patient safety requirement at all hours in all care settings
- Add uric acid control and allopurinol management monitoring at a 1-minute interval covering serum uric acid trends, allopurinol dosing records, and oxypurine monitoring
- Add renal function and urological surveillance at a 1-minute interval covering GFR trending, renal ultrasound scheduling, and obstructive uropathy escalation protocols
- Add dysphagia and feeding safety monitoring at a 2-minute interval covering aspiration risk documentation, texture modification prescriptions, and gastrostomy management
- Add dystonia and movement disorder management at a 2-minute interval covering baclofen pump records, DBS parameters, and movement disorder medication documentation
- Add behavioral medication and neuropsychiatric management at a 2-minute interval covering psychotropic medication reconciliation, adverse drug reaction monitoring, and behavioral escalation alerting
- Add cognitive and communication support monitoring at a 2-minute interval covering AAC device records and quality of life documentation
- Add HPRT1 registry and genetic counseling coordination at a 5-minute interval
- Add authentication and EHR synchronization
- Enable SSL monitoring across all patient-facing, residential care, and registry integration domains
- Publish the automatic status page URL in residential care facility workstations, emergency department clinical systems, and neurology and metabolic disease clinic portals
Conclusion
Lesch-Nyhan Syndrome care tech platforms hold the comprehensive clinical infrastructure that makes expert management of one of medicine's most biochemically and behaviorally complex rare disorders possible across the lifespan — uric acid control and allopurinol management platforms maintaining the continuous serum uric acid surveillance and dosing precision that prevents the gout, nephrolithiasis, and renal urate nephropathy that historically caused premature mortality in Lesch-Nyhan Syndrome before effective xanthine oxidase inhibition was available, renal function and urological surveillance platforms monitoring GFR trajectories, xanthine lithiasis risk, and urinary purine excretion patterns in the organ system most vulnerable to the chronic biochemical consequences of HPRT1 deficiency even with optimal allopurinol management, self-injurious behavior management and restraint protocol platforms providing the 24/7 availability of individualized behavioral management documentation that every care staff member, residential caregiver, and family member interacting with a Lesch-Nyhan Syndrome patient requires to implement the protective restraint specifications, dental protection protocols, and behavioral intervention plans that prevent the compulsive self-biting and self-injury that is the most distinctive and medically demanding behavioral phenotype in any genetic neurological disorder, dystonia and movement disorder management platforms maintaining the intrathecal baclofen pump programming records, deep brain stimulation parameter documentation, and oral medication regimen information that acute neurological presentations in Lesch-Nyhan Syndrome require to be immediately accessible to emergency and acute care clinicians, dysphagia and feeding safety platforms maintaining the aspiration risk documentation and texture modification prescriptions that protect Lesch-Nyhan Syndrome patients from aspiration pneumonia — a major cause of acute morbidity — in every clinical and residential care setting, behavioral medication management platforms providing complete and current psychotropic medication documentation to the wide range of clinicians who may encounter Lesch-Nyhan Syndrome patients in behavioral crisis or acute illness contexts, communication support platforms enabling patients with dysarthria and cognitive impairment to express preferences including the paradoxical protective restraint requests that are a unique and important feature of Lesch-Nyhan Syndrome patient experience, and HPRT1 registry platforms generating the natural history evidence that characterizes the genotype-phenotype spectrum from partial HPRT1 deficiency through classic Lesch-Nyhan Syndrome and documents the biochemical control quality and behavioral management outcomes that define program excellence — platforms that cannot undo the uric acid nephropathy from missed serum uric acid monitoring, the acute gout episodes from inaccessible allopurinol dosing records, the self-injury events from unavailable restraint protocol documentation, the aspiration pneumonia from interrupted dysphagia management platforms, or the neurological decompensation from inaccessible dystonia medication and baclofen pump records, in a condition where the care team's commitment to simultaneous biochemical vigilance, behavioral safety infrastructure, and neurological management continuity across the full complexity of HPRT1 deficiency is the defining standard of excellence in Lesch-Nyhan Syndrome management. External monitoring from Vigilmon provides the independent, outside-in availability view that Lesch-Nyhan Syndrome program directors need to catch platform failures before they affect uric acid control, renal surveillance, behavioral protocol accessibility, or the dysphagia and dystonia management that makes comprehensive lifelong care for this X-linked purine metabolism disorder clinically and behaviorally safe.
Start monitoring your Lesch-Nyhan Syndrome care tech platform for free at vigilmon.online — HTTP/HTTPS monitoring, multi-region consensus alerting, SSL certificate monitoring, automatic status page, Slack and PagerDuty integration. No agent required. No credit card.
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